Provider Demographics
NPI:1205199932
Name:SPEAKTACULAR SPEECH THERAPY, PLLC
Entity Type:Organization
Organization Name:SPEAKTACULAR SPEECH THERAPY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:A
Authorized Official - Last Name:SLUDER
Authorized Official - Suffix:
Authorized Official - Credentials:CCC-SLP
Authorized Official - Phone:336-671-9599
Mailing Address - Street 1:8385 CHEVAL ST
Mailing Address - Street 2:
Mailing Address - City:CLEMMONS
Mailing Address - State:NC
Mailing Address - Zip Code:27012-9122
Mailing Address - Country:US
Mailing Address - Phone:336-671-9599
Mailing Address - Fax:336-740-9075
Practice Address - Street 1:8385 CHEVAL ST
Practice Address - Street 2:
Practice Address - City:CLEMMONS
Practice Address - State:NC
Practice Address - Zip Code:27012-9122
Practice Address - Country:US
Practice Address - Phone:336-671-9599
Practice Address - Fax:336-740-9075
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-18
Last Update Date:2012-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5216235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty